Wang Ching-Jen, Kuo Yur-Ren, Wu Re-Wen, Liu Rue-Tsuan, Hsu Chi-Shiung, Wang Feng-Sheng, Yang Kuender D
Department of Orthopedic Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan.
J Surg Res. 2009 Mar;152(1):96-103. doi: 10.1016/j.jss.2008.01.026. Epub 2008 Mar 7.
This prospective study compared extracorporeal shockwave treatment (ESWT) with hyperbaric oxygen therapy (HBO) in chronic diabetic foot ulcers.
Seventy-two patients with 72 chronic diabetic foot ulcers were randomly divided into two groups of similar demographics with 34 patients with 36 ulcers in the ESWT group and 36 patients with 36 ulcers in the HBO group. Patients in the ESWT group received 300 + 100/cm(2) impulses of shockwave at 0.11 mJ/cm(2) energy flux density every 2 wk for 6 wk, whereas patients in the HBO group received HBO daily for 20 treatments. The evaluations included clinical assessment of the ulcers with photo-documentation, blood flow perfusion scan, bacteriological examination, histological study, and immunohistochemical analysis.
The overall results showed completely healed in 31%, improved in 58%, and unchanged in 11% for the ESWT group and 22% completely healed, 50% improved, and 28% unchanged for the HBO group. The ESWT group showed significantly better clinical results and local blood flow perfusion, higher cell concentration, and activity than the HBO group. On immunohistochemical analysis, the ESWT group demonstrated significant increases in endothelial nitric oxide synthase, vessel endothelial growth factor, and proliferation cell nuclear antigen expressions and a decrease in transference-mediated digoxigenin-deoxy-UTP nick end-labeling expression than the HBO group.
ESWT appears to be more effective than HBO in chronic diabetic foot ulcers.
这项前瞻性研究比较了体外冲击波治疗（ESWT）与高压氧治疗（HBO）对慢性糖尿病足溃疡的疗效。
72例患有慢性糖尿病足溃疡的患者被随机分为两组，两组患者的人口统计学特征相似，ESWT组有34例患者，36处溃疡；HBO组有36例患者，36处溃疡。ESWT组患者每2周接受一次冲击波治疗，能量通量密度为0.11 mJ/cm²，每次治疗300 + 100/cm²脉冲，共治疗6周；而HBO组患者每天接受高压氧治疗，共治疗20次。评估内容包括对溃疡进行临床评估并拍照记录、血流灌注扫描、细菌学检查、组织学研究和免疫组织化学分析。
总体结果显示，ESWT组31%的溃疡完全愈合，58%有所改善，11%无变化；HBO组22%的溃疡完全愈合，50%有所改善，28%无变化。ESWT组的临床效果和局部血流灌注明显优于HBO组，细胞浓度和活性也更高。免疫组织化学分析显示，与HBO组相比，ESWT组内皮型一氧化氮合酶、血管内皮生长因子和增殖细胞核抗原的表达显著增加，而转移介导的地高辛-脱氧UTP缺口末端标记表达减少。
在慢性糖尿病足溃疡的治疗中，ESWT似乎比HBO更有效。
